<div class="row-fluid">
	<div class="span11 offset1">
		<form action="<?php echo BASE_URL?>map-management/add-province" method="post" class="form-horizontal">
			 <div class="control-group">
				<label class="control-label" for="provinceName">Province Name</label>
				<div class="controls">
					<input type="text" id="provinceName" placeholder="Province Name" name="data[province][province_name]" class="input-xxlarge" required>
				</div>
			</div>
			<div class="control-group">
				<label class="control-label" for="Alias">Alias</label>
				<div class="controls">
					<input type="text" id="Alias" placeholder="Alias" name="data[province][alias]" class="input-xxlarge" required>
				</div>
			</div>
			<div class="control-group">
				<label class="control-label" for="areaShape">Area Shape</label>
				<div class="controls">
					<div class="btn-group" data-toggle="buttons-radio">
					    <label class="btn">
					        <input type="radio" name="data[province][shape]" id="rect" value="rect"> Rectangle
					    </label>
					    <label class="btn">
					        <input type="radio" name="data[province][shape]" id="circle" value="circle"> Circle
					    </label>
					     <label class="btn active">
					        <input type="radio" name="data[province][shape]" id="poly" value="poly" checked> Poly
					    </label>
					</div>
				</div>
			</div>
			<div class="control-group">
				<label class="control-label" for="provinceLatLon">Latitue &amp; Langtitute</label>
				<div class="controls">
					<input type="text" id="provinceLatLon" placeholder="lat & lon" name="data[province][lat_lon]" class="input-xxlarge" required>
				</div>
			</div>
			<div class="control-group">
				<label class="control-label" for="provinceColor">Color</label>
				<div class="controls">
					<input type="text" id="provinceColor" placeholder="Color" name="data[province][color]" class="input-xxlarge" required>
				</div>
			</div>
			<div class="control-group">
				<div class="controls">
					<button type="submit" class="btn">Submit</button>
					<button type="button" class="btn" onclick="javascript:history.go(-1)">Cancel</button>
				</div>
			</div>
		</form>
	</div>
</div>

